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主动脉窦动脉瘤破裂合并妊娠前置胎盘的围手术期护理一例

Nursing Care of Mental Disorders Caused by Sodium Nitroprusside Used for Patients with DeBackey Ⅲ Aortic Dissection

【摘要】　目的　Ⅲ型主动脉夹层非体外循环腔内支架隔离术在围手术期应用硝普钠控制性降压易导致精神失常，总结相关护理经验。　方法　2009年7月-2010年2月确诊Ⅲ型主动脉夹层动脉瘤患者36例，围手术期应用硝普钠控制性降压，均采用非体外循环主动脉腔内隔离术治疗，排除手术、麻醉等因素所致脑损伤而产生的术后精神异常。　结果　有5例出现不同程度精神失常，经加用口服降压药，减少硝普钠泵入剂量，缩短硝普钠使用时间，经过精心治疗及护理，患者精神异常症状逐渐减轻直至消失。　结论　长期、大剂量应用硝普钠易导致精神失常，需加强护理，及时发现，及时处理。【Abstract】　Objective　To summarize the nursing experiences for mental disorders caused by sodium nitroprusside used to cure hypertension in patients receiving off-pump intervention surgery for DeBackey Ⅲ aortic dissection.　Methods　From July 2009 to February 2010, 36 patients were diagnosed to have DeBackey Ⅲ aortic dissection in our department. All patients received off-pump intervention surgery. We used sodium nitroprusside to control hypertension during the operation. Mental disorders caused by brain damage from surgery, anesthesia and other factors were ruled out.　Results　Five patients suffered from psychiatric disorders. Oral antihypertensive drugs were used, and we reduced the dose and shortened the time of using sodium nitroprusside. After intensive treatment and care, the symptoms of mental disorders alleviated and disappeared.　Conclusion　Long-term and large dose of sodium nitroprusside can easily lead to mental disorders, which requires intensive care, timely detection and treatment.

Postoperative Care of One Infective Endocarditis Patient with Isolated Kidney on the Right Side

ObjectiveTo discuss the key nursing points for patients with infective endocarditis and congenital isolated kidney after valve replacement. MethodsIn December 2012, one infective endocarditis patient with isolated kidney underwent heart valve replacement in our hospital. In addition to actively preventing postoperative infection of the heart valve, our nursing focused mainly on the isolated kidney protection and monitoring, and the related complications. ResultsThe surgery was successful, and the isolated kidney was effectively protected. The patient recovered and was discharged from the hospital. ConclusionFor patients with congenital isolated kidney with infective endocarditis, patients' urine output per hour and 24 h discrepancy quantity should be closely observed after valve replacement surgery. It is also very important to intervene early and carry out comprehensive protection of the renal function.

持续气道正压治疗婴幼儿心脏术后并发低氧血症的护理

【摘要】 目的 总结鼻塞式持续呼吸道正压通气治疗心脏术后婴幼儿低氧血症的效果和护理。 方法 2008年1-12月对26例心脏术后并发低氧血症的患儿使用鼻塞式持续呼吸道正压通气，吸入氧浓度60%～80%，治疗时间24～48 h。 结果 23例治疗24～48 h后临床症状完全缓解。3例患儿由于心功能差，在治疗过程中出现进行性呼吸困难，再次行气管插管机械通气，2例治愈，1例死亡（死于低心排综合征）。 结论 鼻塞式持续呼吸道正压通气是治疗患儿心脏术后低氧血症的有效方法。

脉波轮廓温度稀释连续心排量测量技术在心脏直视术后的临床监测及应用

目的探讨脉波轮廓温度稀释连续心排量测量技术（PICCO）在心脏直视术后患者血流动力学参数监测中的应用及效果。 方法2011年1月－2012年6月采用PICCO监测20例术后危重患者的心功能指数（CI），全心舒张末期容积指数（GEDI），血管外肺血指数（ELWI），对监测结果为CI＜3 L/（min·m2）、GEDI＜700 mL/m2、ELWI＞10 mL/kg的患者，治疗上慎重增加容量，同时增加儿茶酚胺类药物剂量的对策；对CI＜3 L/（min·m2）、GEDI＞700 mL/m2、ELWI＞10 mL/kg的患者，治疗上予以增加儿茶酚胺类药物剂量同时严格控制容量，每日严格泵入液体量及管喂量的处置方式；对CI＞3 L/（min·m2）、GEDI＜700 mL/m2、ELWI＞10 mL/kg、SVRI＜900 kPa·s/（min·m2）的患者，则采取容量增加慎重同时增加儿茶酚胺类药物剂量，调节去甲肾上腺素用量的方式。 结果经PICCO严密监测以及药物和容量调整，19例患者循环逐渐稳定，均拔除气管插管后转出重症监护室（ICU）回病房继续治疗，1例因全心功能衰竭，抢救无效死亡。 结论通过应用PICCO对心脏直视术后患者血流动力学参数进行监测，能更直观有效、及时精确的找准血流动力学不稳定因素，对症下药，改善患者心功能情况，减少ICU住院天数，提高患者治愈率。

Research progress on gastrointestinal hemorrhage after cardiac surgery

Although the incidence of gastrointestinal hemorrhage after cardiac surgery is low, the mortality rate is high. Early detection and diagnosis of gastrointestinal hemorrhage are difficult. The high risk phases including preoperation, intraoperation and postoperation. Preoperative high risk comorbidities include gastrointestinal ulcer, hypertension, coronary heart disease and chronic renal failure. Intraoperative high risk factors include decreased gastrointestinal blood perfusion due to cardiopulmonary bypass, inflammatory factors releasing, coagulation disorders, and thrombosis. Postoperative high risk factors include hypotension, low cardiac output, prolonged mechanical ventilation, etc. This article retrospectively summarized high-risk factors and pathogenesis of gastrointestinal hemorrhage after cardiac surgery, in order to improve prevention and treatment of gastrointestinal hemorrhage.

Analysis of Risk Factors for Death in Patients Undergoing Continuous Renal Replacement Therapy after On-pump Cardiovascular Surgery

ObjectiveTo retrospectively evaluate the risk factors of mortality in postoperative acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT) after cardiopulmonary bypass (CPB). MethodsWe retrospectively analyzed the clinical data of 66 patients (38 males and 28 females with mean age of 59.11±12.62 years) underwent CRRT after cardiovascular surgery in our hospital between May 2009 and June 2014. The patients were divided into a survival group (18 patients) and a death group (48 patients) according to treatment outcome at discharge. Univariate analysis for risk factors of death was carried out for preoperative characteristics and lab results among study population. Significant univariate factors were then further analyzed by multivariable logistic regression models. ResultsSignificant predictors of death included blood transfusion volume during operation, peak level of blood sugar and lactate during operation, the total bilirubin level and platelet count on the first day after operation, hypotension on the first day after operation, pulmonary infection, multiple organ dysfunction syndrome (MODS) and the interval time of oliguria and CRRT (P<0.05). Logistic regression showed that there were statistical differencs in hypotension on the first day after operation, postoperative platelet count, and interval time of oliguria and CRRT respectively (P<0.05). ConclusionImproving intraoperative management, reducing bleeding and blood transfusion, controlling blood sugar level, dealing with complications such as hypotension, pulmonary infection and MODS more aggressively, starting CRRT when needed may be helpful to reduce mortality. Monitoring of the blood pressure and platelet count on the first day after operation is useful for prognosis estimation.

全胸腔镜体外循环下行二尖瓣瓣膜置换术的围手术期护理

目的　总结全胸腔镜体外循环下行二尖瓣瓣膜置换的围手术期护理方法与经验。 方法　对2011年7月－2012年4月收治的12例二尖瓣病变拟行瓣膜置换术患者的术前、术后护理措施进行回顾分析，并就术后加强呼吸、循环、引流、疼痛、肢体运动等方面的护理问题进行详细阐述。 结果　12例患者手术顺利，术后7～13 h拔出气管插管，术后21～68 h由重症医学科（ICU）转回病房。11例术后48 h内拔出胸腔闭式引流管，1例82 h拔出引流管。患者均于术后7～12 d痊愈出院。 结论　充分的术前准备及严密的术后观察护理，对预防并发症的发生和患者康复有积极推动作用。

Advances in the prevention and management of heart disease in pregnancy

With the opening of the two child policy in China, the number of pregnant women has increased. Pregnancy has a huge impact on the cardiovascular system, and heart disease during pregnancy increases the risk of maternal heart failure and death, intrauterine growth retardation, and the risk of complications such as premature birth. Pregnancy with heart disease ranks first among indirect obstetric deaths in China. Reducing maternal mortality is a global goal of the World Health Organization. Thus, to strengthen the prevention and management of patients with critical heart disease during pregnancy is important. However, clinical decision-making and management of pregnant women with heart disease is still controversial. This article combines relevant literature of pregnancy and heart disease published in recent years and reviews of relevant diagnostic and therapeutic methods, to provide clinical reference for pregnant women with heart disease preventive care and management of the whole strategy.

Perioperative Care for Full Thoracoscopic Bipolar Radiofrequency Ablation of Simple Atrial Fibrillation

目的　探讨全胸腔镜下Box Lesion双极射频消融术治疗单纯性房颤的围手术期护理方法与要点。方法　对2011年5月－2011年9月拟行全胸腔镜下Box Lesion双极射频消融（双侧肺静脉+左心房后壁隔离）治疗的6例心房纤颤患者，术前做好心理疏通及各项手术准备；术后采取各项对症措施加强呼吸道、心律、引流、疼痛等监测与护理。 结果　6例患者均在术后即刻转复为窦性心律，无死亡，无并发症发生，术后7 d均顺利出院。出院后4周复查均为窦性心律。 结论　全胸腔镜下行Box-lesion双极射频房颤术是治疗单纯性房颤的有效手段，严密的观察及精心护理是手术顺利施行和疾患治愈的重要因素。